People sometimes use the term ADHD interchangeably with attention deficit disorder (ADD), to refer to ADHD without hyperactivity.
However, the American Psychiatric Association (APA) only recognizes only ADHD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not provide criteria for ADD. Doctors now consider ADD an outdated term.
What are ADHD and ADD?
ADHD describes a neurodevelopmental disorder that features a variety of symptoms. These may include poor attention, hyperactivity, and poor impulse control.
For a diagnosis of ADHD, the symptoms must be severe enough to interfere with a person's functioning.
ADHD can make it hard to focus on routine tasks.
There are three subtypes of ADHD:
Predominantly inattentive ADHD features forgetfulness, disorganization, and lack of focus. This was previously known as ADD.
Predominantly hyperactive-impulsive ADHD involves restlessness and impulsive decisions, but not inattention.
Combined ADHD features inattention, hyperactivity, and impulsivity.
The signs and symptoms of ADHD vary depending on the type of disorder.
The DSM-5 lists the diagnostic criteria for a range of mental conditions, including ADHD.
Inattentive ADHD (previously ADD)
People with this form of ADHD, (previously ADD) will not have signs of hyperactivity, but, they may have the following symptoms:
- difficulty organizing tasks or activities
- being easily distracted from the task at hand
- regularly forgetting daily activities
- regularly losing things that they need to complete tasks
- avoiding, disliking, or postponing tasks that are not interesting
- regularly losing focus on schoolwork, chores, or duties in the workplace
- not following clear directions
- seeming not to listen when being spoken to
- regularly making careless mistakes
- trouble holding attention on tasks or social activities
People with hyperactive-impulsive type ADHD will have the following symptoms:
They will show signs of:
- being always being "on the go"
- squirming in their seat, fidgeting with objects on their desk, or tapping their hands or feet
- regularly leaving their seat at inappropriate times, such as during work meetings, classes, or presentations
- talking excessively
- having trouble waiting their turn
- interrupting others in conversation or intruding on activities
- blurting out answers before a question is finished
Good focus on some tasks
A person with ADD or ADHD can usually focus well on activities they enjoy.
People with ADHD will often have problems with disorganization and forgetfulness on a regular basis. They may also struggle to focus on things that are unimportant to them.
However, if a topic interests them, they may focus on it completely, shutting out everything else.
It will be most difficult to focus when undertaking regular, less interesting tasks, such as the laundry, doing homework, or reading office memos.
Showing any combination of the above symptoms alone is not enough for a diagnosis of ADHD. A person who misses an appointment or talks a lot does not necessarily have ADHD.
To have a diagnosis:
- A child must have at least six of the above symptoms.
- An adolescent or adult must have at least five of the above symptoms.
- The symptoms must be present for at least 6 months before diagnosis
- Three or more symptoms of inattentive or hyperactive-impulsive behavior must have been present before the age of 12 years.
The severity of symptoms is also important.
Everyone forgets their keys from time to time, and many children do not like doing homework. In a person with ADHD, however, these symptoms severely affect their social, school, or work life.
The symptoms will also be inappropriate for a person's developmental level. An example of this might be a high school student who regularly climbs on top of the classroom table.
Symptoms must also appear in multiple environments, such as school, work, home, and in social situations. There needs to be clear evidence that the symptoms interfere with the individual's quality of life.
A doctor will also consider whether another disorder can explain these symptoms.
- Is a child simply rebelling against authority?
- Are their behaviors a cry for attention?
With possible cases of ADHD or ADD in children, a school psychologist may observe the child's behavior in their classroom environment, to help make a proper diagnosis.
Other conditions with similar symptoms
The behaviors must also not be due to another disorder.
Children with ADHD have a higher risk of other disorders. The Centers for Disease Control and Prevention (CDC) estimate that about two-thirds of all children with ADHD have other disorders as well.
A child with ADHD may have behavioral problems, too, including:
- oppositional defiant disorder
- conduct disorder
- other learning disorders
- anxiety and depression
These other disorders may make it difficult to diagnose or treat ADHD. They can also make it harder for the child to function and fit in, and they can add pressure on the parents and teachers.
Getting a thorough diagnosis increases the chances of starting appropriate treatment in the early stages. Appropriate treatment can make it easier to manage ADHD and its effects.
Lifestyle measures and medications may help. A doctor will advise on the treatment options available to treat ADHD.
Encouraging physical activity and exercise can be beneficial.
Parents can encourage and help children by:
- setting and following a routine
- creating a quiet space
- keeping the home organized, as a good example
- giving plenty of praise
- cutting unnecessary tasks out of the weekly program
- finding activities and hobbies that suit their activity levels and interests
- helping them to make and follow a schedule and lists of things to remember
- allowing plenty of time to complete tasks
Other lifestyle measures that can help include:
- eating a balanced, healthful diet
- getting plenty of exercise
- establishing good sleeping practices
- co-ordinating with the school, if the condition affects a child
When to see a doctor
If a person shows any of the above symptoms, and these symptoms appear to be holding back their progress at school or at work or disrupting relationships, it may be a good idea to seek medical help.
A qualified healthcare professional must carry out any diagnosis of ADD or ADHD. They will decide if the individual meets the required criteria.
ADHD in adults and children
The symptoms of ADHD can change as people mature. Adults and children may experience the same symptoms in different ways.
Children with symptoms of hyperactivity are more likely to appear "in motion" all the time.
They may run, climb, and play excessively, even when it is inappropriate. In classrooms, they may get up, constantly cause distractions, and talk excessively.
Children will often fidget in their seat, squirm, play with things in their hands, and have trouble sitting still.
In adults, hyperactivity may show up as a feeling of constant restlessness. In addition, the person may constantly tap their feet, play with a pencil, or fidget.
They may move from job to job at the first sign of boredom and leave uninteresting projects half-finished. They may still find it hard to sit still for extended periods.
Impulsive behaviors show up in adults and children in slightly different ways.
Children often appear rude as they blurt out answers, move to the front of a line, interrupt others, or run in front of traffic without looking.
In adults, impulsive behaviors may include:
- spending money randomly
- driving recklessly
- having a careless sexual life
They may also say what is on their mind without thinking about whether it might offend or hurt another person's feelings.
In children, inattention can lead to:
- careless mistakes in schoolwork
- a short attention span
- incomplete homework
- unfinished activities
- not listening when someone speaks to them directly
- lack of attention to detail
In adults, the symptoms of inattention are similar, but they emerge in different ways.
- forget to do regular tasks, such as taking out the garbage, picking their kids up from school, or filing paperwork
- lose or forget things they use regularly, such as keys, phone numbers, and important papers.
- Adults with ADD may also have problems with self-motivation.
The symptoms of ADHD and ADD overlap, but they are different conditions. A person with ADD does not have a problem with hyperactivity, only with paying attention.
Current diagnostic criteria do not list ADD as a separate condition, but groups the symptoms under the name inattentive ADHD.
People with ADHD and ADD can face difficulties in their daily life, both in childhood and as adults.
It can take some time to get a correct diagnosis, but once this is done, a doctor can help the person through lifestyle changes and possibly medication.